DESCRIPTION (provided by investigator): This study proposes to evaluate the effectiveness of an early intervention for children with cleft lip and palate to facilitate speech and vocabulary development and prevent the habituation of compensatory articulation use in Brazil. This research will be conducted at the Hospital for Rehabilitation for Craniofacial Anomalies-University of Sao Paulo-Bauru in collaboration with Dr. Inge Trindade with the companion grant of Dr. Nancy Scherer, R21DC009654, and 7-1-2009 to 6-30-2011. This application will utilize methodology, training manuals and modules developed as part of an R21 that is assessing the efficacy of the Enhanced Milieu Teaching with Phonological Emphasis (EMT/PE) for young children with CLP in the US in a randomized comparison with a traditional speech intervention. The specific aims of the proposed investigation will: 1) Translate intervention training components of EMT/PE into Portuguese and develop a protocol for video demonstration of EMT/PE, 2) Train Speech-Language Pathologists and graduate students at Hospital for Rehabilitation of Craniofacial Anomalies-University of Sao Paulo (HRCA-USP) in EMT/PE. Three SLP's at HRCA-USP-Bauru and 2 satellite clinics in the Sao Paulo area and Rio Grande do Sul will be trained to reliably conduct the EMT/PE. Graduate students in speech-language pathology at HRCA-USP and East Tennessee State University will be trained in research methodology associated with the EMT/PE project, and 3) Conduct a group study with random assignment to an EMT/PE intervention treatment or a business as usual control group to assess the delivery of the EMT/PE intervention for children with CLP in Brazil. The study will examine 24 children with nonsyndromic cleft lip and/or palate at three time points; pre-treatment, (T0) immediately following treatment (T1) and 3 months following treatment (T2). Speech and language outcome measures to be assessed in the evaluations and during the intervention include vocabulary measures from parent report and language sample (i.e., the number of different words), vocalization rate, turn-taking and parent word use at home (LENA) and speech measures (i.e., consonant inventory, intelligibility rating, percent consonants correct, and percent of compensatory articulation use). The data will be analyzed using the difference-in-differences (DID; Ashenfelter & Card, 1985) approach to test for treatment effects and maintenance of treatment effects. The gains observed in the treated children will be contrasted against any gains observed in the control children.